Doctors Academy - Breast COPY Flashcards
What is the blood supply to the breast?
Anterior intercostal branches from the internal thoracic artery
thoracoacromia branches
lateral thoracic artery
lateral mammary arterys
what are the risk factors for breast cancer
Early menache
late menopause
not breast feeding
atypical breast hyperplasia
What does triple assessment compose of?
Clinical examination
Radiological imaging
core biopsy
At what age people entered in to the national breast screening program
between 47/53 - 70/73
How do you screen patients who are below the age of 40?
do an USS
If patients of any age present with a lump, what radiological investigations do you do?
mammogram and USS
What 3 factors does the Nottingham prognostic indicator involve? and how is the score calculated?
- Size = 0.2 x size in cm
- Number of nodes
- 0 = 1 point
- 1-3 = 2 points
- >3 = 3 points
- Grade
- Grade 1 = 1 point
- Grade 2 = 2 points
- Grade 3 = 3 points
you add these all together for a score.
what is a poor NPI number?
> 5.4
What non surgical treatment can be given to a patient with breast cancer who is ER positive
give tamoxifen for 10 years and then anastrozole
what non surgical treatment can be given to a patient with breast canacer who is HER 2 positive
Neoadjuvant Chemotherapy
what are the risks of giving tamoxifen?
- increased risk of blood clots
- increased risk of endometrial cancer
- need to monitor LFTs every 6 months
What genes are associated with breast cancer
- BRACA
- PALB2
- TP53
- CHD1
by what percentage does a mastectomy reduce the risk of breast cancer in a pateint with the BRACA gene?
reduces risk by 90%
what are some of the features of phlodes tumour?
- rapidly growing mass
- leaflike architecture
- intra-canalicular growth pattern
- cleft like spaces
- hypercellular stroma
- haematogenous spread
When breast cancer metastasises to bone, which bones does it commonly affect?
The axial skeleton
which cancers produce osteolytic bone metastasis?
- Breast
- melanoma
- thyroid
- renal cell carcinoma
- lung cancer
which cancers produce osteosclerotic bone mets?
prostate cancer
What is the manamgnet of fibroadenoma?
- if >40mm consider removal
- if <40mm conservative
what are the features of periductal mastitis and what is the treatment?
- May present with features of inflammation, abscess or mammary duct fistula
- Strongly associated with smoking
Treatment: antibiotics and review in 1 week to rule out inflamatory breast cancer
what are the features of duct ectasia?
- Patients usually present with nipple discharge, which may be from single or multiple ducts (usually present age >50 years
- The discharge is often thick and green
what is the treatment of breast abscesses?
USS guided drainage
NB: patients can continue to breast feed
how do you assess a patient for susspected breast cancer if they are pregnant?
- Mamogram with fetal shielding
- x ray + USS
- Core biopsy
what is the treatment of breast cancer in a pregnant patient
- Mastectomy or WLE - do any operation after the first trimester
- Radiotherapy after delivery
If the patient needs chemotherapy this can be done after the 1st trimester
which patients require a breast MRI
- Prior to neoadjuvant chemotherapy
- patients with BRACA genes
- Ptients with strong family history of breast cancer
- patients presenting with a lump + have breast implants
- any patient where there is incongruity between USS and assessment??
what other cancer are males and females at risk of developing if they have BRACA gene?
Males = Prostate
Females = Ovarian
Which patients require neoadjuvant chemotherapy?
- Large tumours (>5cm)
- locally advanced
- positive axillary lymph node
- ER -ve, HER 2 +ve
What are the indications for adjuvant chemotherapy
- HER2 +ve
- Tripple -ve
- Axillary node +ve
what are the indications for radiotheraphy
- WLE / mastecomy
- Axillary node +ve with mastectomy
what is the most important prognostic factor in breast cancer.
nodal status
what are the features of intraductal papiloma and what is the treatment
- single duct discharge.
- The fluid is often clear, although it may be blood stained.
- If the fluid is tested with a labstix (little point in routine practice) then it will usually contain small amounts of blood.
Treatment: A microdochectomy may be performed.
what should you do if the imaging and biopsy results are not concordant
either MRI or WLE
What is the treatment for duct ectasia
Hadfields procedure
What is the most common hormonal status in women with breast cancer
Oestrogen and HR2 negative
Comedo necrosis + calcifications are signs of which form of breast cancer?
DCIS
